Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies

Background and aim Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies. Methods and results PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05–1.10, I2 = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00–1.18, I2 = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10–1.27, I2 = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92–1.02, I2 = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02–1.10, I2 = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11–1.18, I2 = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06–1.23, I2 = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14–1.19, I2 = 94.0%, n = 48) for all-cause mortality. There was a positive dose–response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association. Conclusion This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate

Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study

Background Safe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions should be focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery. Prolonged attempts at vacuum delivery are associated with neonatal morbidity and maternal trauma, especially so if the procedure is unsuccessful and a cesarean is performed. Objective The aim of the study was to assess if ultrasound measurements of fetal position and station can predict duration of vacuum extractions, mode of delivery, and fetal outcome in nulliparous women with prolonged second stage of labor. Study Design We performed a prospective cohort study in nulliparous women at term with prolonged second stage of labor in 7 European maternity units from 2013 through 2016. Fetal head position and station were determined using transabdominal and transperineal ultrasound, respectively. Our preliminary clinical experience assessing head-perineum distance prior to vacuum delivery suggested that we should set 25 mm for the power calculation, a level corresponding roughly to +2 below the ischial spines. The main outcome was duration of vacuum extraction in relation to ultrasound measured head-perineum distance with a predefined cut-off of 25 mm, and 220 women were needed to discriminate between groups using a hazard ratio of 1.5 with 80% power and alpha 5%. Secondary outcomes were delivery mode and umbilical artery cord blood samples after birth. The time interval was evaluated using survival analyses, and the outcomes of delivery were evaluated using receiver operating characteristic curves and descriptive statistics. Results were analyzed according to intention to treat. Results The study population comprised 222 women. The duration of vacuum extraction was shorter in women with head-perineum distance ≤25 mm (log rank test 25 mm. The head-perineum distance was associated with spontaneous delivery with area under the curve 83% (95% confidence interval, 77–89%) and associated with cesarean with area under the curve 83% (95% confidence interval, 74–92%). In women with head-perineum distance ≤35 mm, 7/181 (3.9%) were delivered by cesarean vs 9/41 (22.0%) in women with head-perineum distance >35 mm (P 35 mm were delivered by cesarean. Umbilical cord arterial pH 35 mm (P < .01). Conclusion Ultrasound has the potential to predict labor outcome in women with prolonged second stage of labor. The information obtained could guide whether vacuum delivery should be attempted or if cesarean is preferable, whether senior staff should be in attendance, and if the vacuum attempt should be performed in the operating theater

Influence of birth weight and adult body composition on 17β\beta-estradiol levels in young women

Higher exposure to light at night per se and through decrease in sleep duration and night shift work may suppress serum melatonin levels, which in turn may increase the reproductive hormone levels. High levels of steroid hormones, especially estrogens, may be associated with an increase of the breast cancer risk. This study investigated whether variation in the sleep duration during one entire menstrual cycle corresponds to variation in estradiol levels in healthy, urban women of reproductive age. Ninthy five regularly menstruating women ages 24-36 collected daily saliva samples for one entire menstrual cycle and recorded the number of hours of sleep per night (sleep duration). Saliva samples were analyzed for concentration of 17-ß estradiol (E2). We documented, after adjustments for sleep duration, a positive relationship between the sleep variation (coefficient of variation in sleep duration - sleep CV) and estradiol levels in women of reproductive age. Mean levels of E2 differed significantly in women from the lowest sleep CV quartile in comparison to other quartiles (p<0.001). The low sleep variation group, that is the women who sleep regularly, had mean E2 levels 60% lower than other groups. These results suggest that sleep variation significantly correlates with E2 levels, while sleep duration does not show a statistically significant relationship. According to the breast cancer development hypothesis, increasing the lifetime exposure to endogenous estrogens could result in higher risk of breast cancer.AnthropologyHuman Evolutionary Biolog